Second Cancer Risk in Childhood Cancer Survivors Treated with Intensity-Modulated Radiation Therapy (IMRT): An Updated Analysis of More Than 10 Years of Follow-Up

Abstract

between two and five years after breast cancer surgery. Patients were deemed adherent to follow-up during COVID-19 if they attended an oncology follow-up appointment (in-person or telemedicine) between March 1 and December 1, 2020; patients were deemed non-adherent if they attended follow-up during the same date range in 2019, prior to the pandemic, but did not follow-up during the COVID-19 period. Adherence during COVID-19 was compared with pre-COVID rates of follow-up. Clinical and demographic data were evaluated as potential predictors of adherence. Local COVID-19 case rates were estimated from public data by ZIP code during the peak of the pandemic in April 2020. Multivariate logistic regression was performed to identify associations with follow-up nonadherence.Results: During COVID-19, 496 (68%) of 734 patients were adherent to follow-up. Of the adherent group, 40.5% had telemedicine visits. The rate of follow-up adherence during COVID-19 was dramatically lower than historic adherence rates of 89-96%, which varied depending on time since resection. On multivariate analysis, adherence was more likely among patients who had received adjuvant radiation therapy (adjusted Odds Ratio [aOR] 1.4; P = 0.032) and smokers (aOR 1.6; P = 0.041). When patients who live in The Bronx were stratified by ZIP code, there was no association (R 2 = 0.01) between local COVID-19 case rates and likelihood of adherence during the COVID-19 pandemic. Conclusion: To our knowledge, this is the first analysis evaluating the potential effect of COVID-19 on cancer survivorship care. We observed a dramatic disruption in long-term follow-up during the COVID-19 period, despite prevalent utilization of telemedicine visits. Overall, if the observed rate of non-adherence persists and patients are not reintegrated into regular follow-up patterns after the COVID-19 period, it has the potential to dramatically affect cancer survival outcomes.